Myositis: Symptoms and Causes Cocaine Alcohol Myopathy may occur right after starting a medication, or may occur after taking a drug for months or years. Sometimes it is caused by an interaction between two different medications. Severe myositis caused by medications is rare. Injury. Vigorous exercise can lead to muscle pain , swelling, and weakness for hours or days after a workout . Inflammation contributes to these symptoms, technically making this a form of myositis. Myositis symptoms after exercise or injury nearly always resolve completely with rest and recovery. Rhabdomyolysis . Rhabdomyolysis occurs when muscles break down quickly. Muscle pain , weakness, and swelling are symptoms of rhabdomyolysis. Urine may also turn a dark brown or red color. Symptoms of Myositis The main symptom of myositis is muscle weakness. The weakness may be noticeable or may only be found with testing. Muscle pain (myalgias) may or may not be present. Continued Dermatomyositis , polymyositis, and other inflammatory myositis conditions tend to cause weakness that gets worse slowly over weeks or months.

The weakness affects large muscle groups, including the neck, shoulders, hips, and back. Muscles on both sides are usually affected. The weakness from myositis can lead to falls and make it difficult to get up from a chair or after a fall. Other symptoms that may be present with inflammatory conditions include: Thickening of the skin on the hands Difficulty swallowing Difficulty breathing People with myositis caused by a virus usually have symptoms of a viral infection , such as runny nose , fever , cough and sore throat , or nausea and diarrhea . But the symptoms of viral infection may go away days or weeks before myositis symptoms begin. Some people with myositis have muscle pain, but many do not. Most muscle pain is not caused by myositis, but by strain injuries, or ordinary illnesses like colds and flu . These and other ordinary muscle pains are called myalgias. Diagnosis of Myositis A doctor may suspect myositis based on a person’s symptoms of muscle weakness or other evidence of myositis. Tests for myositis include: Blood tests. High levels of muscle enzymes, such as creatine kinase , may mean there is muscle inflammation. Other blood tests check for abnormal antibodies that may identify an autoimmune condition.

MRI scan. A scanner using a high-powered magnet and a computer creates images of the muscles. An MRI scan can help identify areas of myositis and changes in the muscles over time. EMG. By inserting needle electrodes into muscles, a doctor can test the response of muscles to electrical nerve signals. EMG can identify muscles that are weak or damaged by myositis. Muscle biopsy . This is the most accurate test for diagnosing myositis. A doctor identifies a weak muscle, makes a small incision, and removes a small sample of muscle tissue for testing. Muscle biopsy leads to a final diagnosis in most people with myositis. There are many causes of muscle weakness and pain more common than myositis, and testing for myositis is not a straightforward process. For these reasons, the process of diagnosing myositis can be long. Continued Myositis | definition of myositis by Medical dictionary Myositis | definition of myositis by Medical dictionary Definition Myositis is a rare disease in which the muscle fibers and skin are inflamed and damaged, resulting in muscle weakness. There are several types of myositis that affect different parts of the body.

Description The persistent inflammation that is associated with myositis develops slowly over weeks to months and often years, with progressive weakening of the muscles. Later in the course of the disease development muscle wasting or shortening (contracture) may develop. Myositis can range in severity from mild to debilitating. The forms of myositis include: Polymyositis (PM) inflames and weakens muscles in many parts of the body, and especially those parts closest to the trunk. With polymyositis, dysphagia (difficulty, discomfort or pain in speaking or swallowing), fatigue , and pain in the muscles are common. PM rarely affects people under the age of 20, with the peak onset between the ages of 30 and 60. Dermatomyositis (DM) affects both the muscle fibers and skin by damaging the tiny blood vessels (capillaries) that supply blood to the muscle and skin, resulting in muscle weakness, pain, and fatigue. In addition the affected person develops a distinctive patchy, reddish rash on the eyelids, cheeks, bridge of the nose, back or upper chest, elbows, knees, and knuckles.

There may also be hardened, tender bumps (possibly caused by inflammation of fat) under the skin. DM can occur at any age and is more common in females than males. Inclusion Body Myositis (IBM) typically begins after age 50, and is characterized by gradual weakening of muscles throughout the body, including the wrists or fingers, development of dysphagia, and atrophy of forearms and/or thigh muscles. Unlike the other types of myositis, IBM occurs more often in men than women, and also does not respond very well to drug therapy. Juvenile myositis (JM) involves muscle weakness, skin rash, and dysphagia in children. A common characteristic of JM is the formation of calcium deposits in the muscle (calcinosis). These deposits are hard and sometimes painful lumps of calcium under the skin that appear on the child's fingers, hands, elbows, and knees. Painful sores may appear if the lumps break through the skin. The child may also suffer from contractures , which is muscle shortening that results in joints staying bent. About half of the children with JM will have pain in their muscles.

Myositis is rare, affecting about 10 in one million people each year. DM and PM affect mostly women in the forties and fifties but men and children can also affect be affected, some at a young age (between the ages of 5 and 15). About 40,000 people in the United States may have this disease, with about 3,000 to 5,000 children affected. Causes and symptoms Myositis is thought to be an autoimmune disease. The body normally fights infections and disease by producing antibodies and white blood cells called lymphocytes in a process called the immune response. In an autoimmune disease, the immune response is overactive, and the immune system attacks and destroys the body's own normal healthy tissues. There is no known cause to the autoimmune response that results in myositis. However, investigators are studying whether the disease is triggered by such environmental agents as the organism that causes toxoplasmosis , Toxoplasma gondii, the Lyme disease organism, Borrelia burgdorferi, the coxsackievirus, or by food allergies . Some cases of IBM are thought to be inherited.

The first symptoms of most types of myositis are weakness and pain in the muscles of the hips and shoulders. The affected person may have trouble getting up from a chair, lifting the arms above the head, or climbing stairs, and may be too tired to walk or stand. DM and PM mostly affects muscles that are close to and within the trunk of the body, while IBM involves a wider range of muscles. Myositis may make it difficult for the person to speak or swallow. When the disease affects the lungs or chest muscles, the person may have difficulty breathing. If the person has DM, they may develop characteristic rashes . Other symptoms may include fever and joint pain and swelling. The first signs of JM is usually a red and patchy skin rash and/or a red or purplish rash on the eyelids or cheeks that look like allergies . Weak muscles may develop at the same time as the rash, or may develop days, weeks, or months after the appearance of the rash. Other symptoms of JM include falling, a weaker voice (dysophonia), or dysphagia. Calcinosis usually develops later during the course of the disease.

Diagnosis Myositis can a difficult disease to diagnose, because it is rare, because the symptoms develop slowly, and because it can be mistaken for other diseases causing muscle weakness such as limb-girdle muscular dystrophy . Many cases of myositis go undiagnosed for years. The health care provider must rule out other conditions such as hypothyroidism , toxin exposure, drug reactions, and genetic disorders that can also affect muscles. The physical examination will include a complete medical history focusing on symptoms and when they occurred, and blood tests for autoantibodies and muscle enzymes (for example, creatine kinase (CK), which when present in the blood indicates muscle damage). Specialized tests may also be performed, including: an electromyogram, which measures the electrical pattern of the muscles a muscle biopsy, in which a small piece of muscle is removed, stained, and examined by microscopic techniques to determine if muscle fibers are damaged and whether the muscle fibers are being infiltrated by cells of the immune system magnetic resonance imaging (MRI) to identify areas of muscle inflammation. Treatment There is no cure for myositis. However, prompt and aggressive treatment may reduce muscle inflammation and prevent muscle weakness from progressing.

Because of the many different kinds of symptoms and a wide range of reactions to different drugs, each person's treatment for myositis should be individualized. Drugs that are used for treatment include corticosteroids , such as prednisone, to reduce inflammation and improve the body's reaction to infections. Corticosteroids are usually taken in the form of pills, but may also be injected. The amount of creatine kinase (CK) levels in the blood are monitored to determine how well the medicine is working. Corticosteroids may produce a number of side effects, such as weight gain, difficulties in fighting infections, psychiatric changes, sleeping troubles, water retention, bone thinning, facial swelling, diabetes, and cataracts . Corticosteroid therapy usually leads to improvement in myositis symptoms within two to three months, after which the dose can be lowered to avoid the side effects. If the dose of corticosteriods is going to be reduced, it is essential to lower the dose over a period of time. Immunosuppressant drugs are used to slow down the immune system's attack on healthy tissue and improve skin rashes.

Persons may be prescribed these drugs to control myositis if they are unable to tolerate corticosteroids or if the corticosteroids are not accomplishing the desired degree of treatment. Immunosuppressant drugs may also be used in conjunction with corticosteroids so that lower doses of corticosteroids can be used. Immunosuppressant drugs include azathioprine, methotrexate, cyclosporine, tacrolimus, etanercept, and mycophenolate mofetil. Intravenous immunoglobulin (IVIg) appears to aid in improving muscle strength in many persons with myositis, particularly those with DM. It may be less effective in PM, and its role in treating IBM requires more study, although it has been shown to help some patients with IBM if they are diagnosed early. Immunoglobulins are normal proteins in the blood that attack anything foreign in the body, such as viruses and bacteria. IVIg is made from donated blood plasma from people with normal immune systems. Side effects from the the use of IVIg include headache and flu-like symptoms.

Topical cream or ointment forms of some of the medicines, such as prednisone and tacrolimus, can be used to heal and soothe the rash associated with DM. Non-steriodal anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen can be used for pain relief. Calcinosis can be treated with prednisone, plaquenil (also called hydroxychloroquine), intravenous immunoglobin (IVIG), cyclosporine, and methotrexate. After drug treatment results in improvement, the affected person begins a program of regular stretching exercises to maintain range of motion in the weakened arms and legs. Physical therapy may be used to prevent permanent muscle shortening. Whirlpool baths, heat, and gentle massages may also provide relief. Adequate rest is necessary, and affected persons should take frequent breaks throughout the day and limit their activity. Patients with throat problems should be evaluated by a speech therapist who can evaluate the swallowing-related problems and make recommendations regarding diet changes and safe swallowing techniques.

Before a woman with myositis becomes pregnant, she should discuss the medicines that she is taking with her health care provider and evaluate the possible risks that she and the baby face if she does become pregnant. Many of the drugs used in the treatment of myositis may be harmful to the fetus or to a breastfed baby. It is recommended that a doctor experienced in the treatment of myositis, assisted by a rheumatologist, dermatologist, or neurologist, be consulted. Oftentimes a patient may have to be treated at a major medical center, where the disease has been seen and treated before. Alternative treatment Various supplements may be used in conjunction with traditional treatment to offset side effects of conventional drug treatment. The use of these suppplements should be approved by the primary health care provider. Immunosuppressant drugs such as methotroxate and cyclophosphamide increase the risk of infection, so a healthy well-balanced diet is required. Methotroxate impairs the body's ability to absorb folic acid , so foods high in folic acid, such as leafy green vegetables, fruits, and folate-fortified breads and cereals are recommended.

The use of folate supplements may also be recommended by the health care provider. Vitamins C and E can be used to help with the pain and infections associated with calcinosis. Corticosteroids may have multiple side effects when taken for long periods of time at high doses. Calcium and Vitamin D are recommended to lower the risk of osteoporosis , a common side effect of prednisone use. Hypertension and fluid retention may be controlled by a diet low in salt. Steroid-induced diabetes (hyperglycemia) can be aided by a diet low in sugar and other simple carbohydrates. Proteinuria, in which the body breaks down protein faster than normal, may mean that more protein should be included in the diet. Weight gain associated with the use of corticosteroids can be managed by the use of the DASH (Dietary Approach to Stop Hypertension) diet, which is high in fruits, vegetables, dietary fiber, and low-fat dairy products. Information concerning this diet, developed by the National Institutes of Health, can be found at [ Weight gain can overtax weakened muscles and should be avoided if possible.

Prognosis The progression of PM and DM varies from person to person, but the lifespan of an affected person is not usually significantly affected. DM responds more favorably to therapy than PM. Overall, many patients do improve and have a functional recovery. About half of the patients recover and can discontinue treatment within 5 years of beginning treatment. In children the chances of a cure are better than in adults, although some children do suffer a relapse. Of the remaining 50%, about 20% will still have the active disease and will require ongoing treatment, while up to 30% may have some remaining muscle weakness. However, IBM is disabling, and most patients will require the use of an assistive device such as a cane, walker, or wheel chair. The older the patient is when contracting IBM, the more rapidly the disease progresses. Prevention Polymyositis - adult: MedlinePlus Medical Encyclopedia People with this condition also must be watched carefully for signs of cancer. Treatment The main treatment is with corticosteroid medicines. The dose of medicine is slowly tapered off as muscle strength improves. This takes about 4 to 6 weeks. You will stay on a low dose of a corticosteroid medicine after that.

Medicines to suppress the immune system may be used for people who do not respond to corticosteroids. Intravenous gamma globulin has been tried, with mixed results. Biologic drugs also may play in part in treating this condition but it is too soon to know. Rituximab appears to be the most promising. If the condition is associated with a tumor , it may improve if the tumor is removed. Outlook (Prognosis) Response to treatment varies based on the complications. As many as 1 in 5 people may die within 5 years of having the condition. Many people, especially children, recover from the illness and do not need ongoing treatment. For most adults, however, immunosuppressant drugs are needed to control the disease. In adults, death may result from: Malnutrition Heart disease, lung disease , or abdominal complications When to Contact a Medical Professional Call your health care provider if you have symptoms of this disorder. Seek emergency treatment if you have shortness of breath and difficulty swallowing. Images Superficial anterior muscles References Greenberg SA. Inflammatory myopathies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed.

Philadelphia, PA: Elsevier Saunders; 2016:chap 69. Nagaraju K, Lundberg IE. Inflammatory Diseases of Muscle and Other Myopathies. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 85. Oddis CV, Reed AM, Aggarwal R, et al. Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum. 2013; 65:314. PMID: 23124935 . Read More IBM Fact Sheet 1 February 2003 Inclusion Body Myositis Written by Dr S Hammans (Consultant Neurologist) Wessex Neurological Centre, Southampton for the Muscular Dystrophy Campaign. What is inclusion body myositis? Inclusion body myositis (IBM) is a disease of muscle, which causes muscles to become thin and weak.

It was recognised as a disease in its own right in the 1960's. It usually occurs in middle to late life and is more common in men than women. We don't know how many people in the UK are affected but it is the most common muscle disease diagnosed after the age of 50. Nevertheless, it is sufficiently rare that most general practitioners will not have looked after patients with IBM before, and many doctors will not have heard of the condition. How will it affect me? IBM is a slowly progressive condition causing a gradual deterioration in muscle strength over the years. Most limb muscles can be affected. In particular the quadriceps (the thigh muscles which extend the knee joint), and forearm muscles that flex the wrists and fingers are commonly weak. Accordingly, patients often notice difficulty with stairs, getting out of a chair and a poor grip. Swallowing muscles are affected in some patients, but most do not encounter severe swallowing problems. The disease typically does not affect muscles of the heart, eye, gut or bladder. It does not affect the function of the brain or sensation, and speech is rarely affected. In general patients do not die of the disease, but most meet with some degree of disability as the disease progresses.

The disease itself is painless. However, weakened muscles can predispose to injuries affecting bones, joints and soft tissues. What causes it? The short answer is that no one knows! A number of theories have been put forward over the years though none have stood the test of time. In some families the condition is inherited, often with earlier onset than the more common sporadic (non-inherited) form. The presence of inflammatory cells in some muscle samples has led to the theory that muscle is damaged by inflammation, caused by a virus or a misdirected immune system. No conclusive evidence to support these theories has been provided. Efforts to suppress the immune system have not led to clear benefit. More recently it has been suggested that IBM is primarily a degenerative disease of muscle with inflammation only secondary to this process. Many researchers in several countries continue to accumulate evidence to shed light on the cause of the disease. How is it diagnosed? There are a number of pieces of evidence that go together to make the diagnosis of IBM: Blood test: When muscles are damaged they release a protein into the blood stream called creatine kinase. This can be detected in a routine blood sample. In some people with IBM the level of this protein in the blood is slightly raised.

This blood test may therefore alert the physician to the possibility of muscle disease. Electromypgraphy (EMG): When healthy muscle contract they fire off a co-ordinated pattern of electrical impulses that can be detected by a tiny needle positioned in the muscle. When sick muscles contract abnormal electrical impulses can be detected. However, although EMG may be helpful it cannot make a definite diagnosis. Muscle biopsy: The definitive test for IBM is a muscle biopsy. The biopsy involves taking a small sample of muscle under local anaesthetic. Laboratory analysis includes a series of stains and reactions, used to highlight different parts of the muscle. In IBM, muscle cells appear damaged. The hallmark of IBM is the inclusion body, which is an abnormal clump of proteins seen in damaged cells. This appearance will allow the pathologist and clinician to confirm the diagnosis of IBM. Because of the indolent nature of muscle weakness in IBM, a diagnosis is sometimes delayed for years after the onset of weakness. In some patients, the initial biopsy may not disclose the diagnosis, and a second biopsy may be necessary. In other forms of myositis steroid treatment may be helpful. If steroids fail to help then this may give rise to consideration of IBM as a possible diagnosis.

Are other members of the family at risk of IBM? Every patient requires individual assessment. The inherited form appears to be rare in the UK. However if IBM is of typical age of onset without evidence of similar disease previously in the family, the risk to other members of the family is very small. Is there any treatment? The presence of inflammatory cells in some biopsies led to suggestions that steroids and other drugs that suppress the immune system might be beneficial in this condition. This immunosuppressant treatment is controversial. Some neurologists are of the opinion that these drugs can give short-term improvement and possibly long-term benefit in slowing the rate of progression, although all agree that these drugs will not prevent muscles from continuing to weaken in the long-term. Other experts argue that any benefits are transient and are outweighed by long-term side effects from the drugs. Recent trials have studied intravenous infusions of human immunoglobulin (IVIG) in IBM. Results have been contradictory, but provide no firm evidence of enduring benefit. Further trials continue, but currently the costs and side-effects do not justify routine treatment of IBM patients with IVIG. In summary, there is currently no proven treatment.

Further research into the cause of the disease will hopefully allow a rational basis to develop effective therapies. What other help is there? Despite the absence of a cure for IBM there are a number of therapists who can help: Physiotherapy: Physiotherapy is not able to make weak muscles strong again. However, appropriate exercises can help to maximise the efficiency of the relatively unaffected muscles. When walking is affected physiotherapists can advise on walking aids (sticks etc). Physiotherapists can also teach people how to transfer between chairs, beds and wheelchairs if and when they become necessary. Occupational therapy: Occupational therapists (OTs) can provide advice and equipment to assist in tasks that become increasingly difficult with weakened muscles. More than any other professional they are in a position to provide valuable help in overcoming the everyday practical problems that IBM patients face. Typically they will observe a patient in their own home before advising on strategies, aids and equipment. Examples include cutlery with chunky handles to make gripping easier, aids to help stair climbing and advice on bathing or showering difficulties. OTs are employed in hospitals and by Social Services. Referral to OTs can be made by hospital doctors, GPs or patients themselves through Social Services.

Speech therapy: Speech therapists also have expertise in swallowing difficulties (dysphagia). In some IBM patients weakened swallowing muscles may cause dysphagia. This may cause fragments of food or drink to enter the windpipe resulting in coughing after meals or chest infections. Some IBM patients reduce their intake resulting in significant weight loss. Speech therapists can advise on strategies to help swallowing. Occasionally it is necessary to use other techniques to give adequate nutrition. Can I help myself in any other way? Exercise is generally helpful, and helps to get the most out of diseased muscles. Falls and injuries however can cause substantial disability. Patients therefore have the difficult task of undertaking regular exercise within their capability but avoiding injury through accident. Because weakened muscles cannot carry an excess load, keeping to an ideal weight is helpful. This may be obvious, but weight control is more difficult when exercise is limited. It is likely that in the future therapeutic trials of drugs in IBM will be organised. If you are interested you should mention this to your physician.

Myositis Support Group Tel: 023 8044 9708 Email: newsletter@myositis.org.uk Website: myositis.org.uk The Muscular Dystrophy Campaign (MDC) is a UK-wide charity that exists in order to create a world where muscle disease is not a barrier to quality or length of life. To this end the charity invests over £1.5 million every year into research with the aim of finding treatments, cures and better management for muscular dystrophy and related conditions. (The charity encompasses over 60 different conditions.) MDC researchers significantly contribute to worldwide advances. The Campaign tracks research developments internationally and brings research information to the attention of scientists, medical and care professionals, MDC members, people with MD and the general public. MDC also provides support for the 30,000 people and the 120,000 friends and family also affected by these conditions through: Information and Advice Services - a telephone, post and web/e-mail based service.

Telephone 020 7720 8055, e-mail info@muscular-dystrophy.org, website Fact Sheets - fact sheets on specific medical conditions and on living and care issues for people affected by muscle disease. Family Care Officers - a nationwide team providing practical support and information. Occupational Therapy - an advisor and provider of specialist information. Specialist Medical Services - Specialist Muscle Centres based in some of the country's leading hospitals. Training and Employment - through the partner charity Neuro Muscular Centre (NMC) providing employment, training and physiotherapy for people with MD. Grants for Equipment to Individuals - through the Joseph Patrick Trust (JPT) contributory funding for some equipment is provided. Local Branches and Representatives - provide a support and fundraising focus in their localities. MDC Membership - through membership, enabling all of those affected by MD and or interested in MDC to have a voice in the future direction of the charity. Membership benefits include a bi-monthly magazine and up-to-date information on developments in research and medical and care services.

BECOME A MEMBER: Contact us on 020 7720 8055, e-mail info@muscular-dystrophy.org or write to Muscular Dystrophy Campaign, 7-11 Prescott Place, London SW4 6BS. HELP US BY MAKING A DONATION: Contact details as above Registered charity no. 205395 Myositis - Singapore Health Hospitals and Doctors Myositis Contributed by Autoimmunity and Rheumatology Centre, Department of Rheumatology & Immunology What is Myositis? Myositis is the medical term for muscle inflammation. This causes the muscle to be weak and can also cause muscle ache and swelling. There are many types of myositis but the major types include: Dermatomyositis – in addition to muscle weakness there is also a rash on the skin especially around the eye-lids and the fingers. Cancer is found in approximately 10% - 20% of cases. Sometimes, the muscle problem develops first. In other cases, the cancer is detected before the myositis. Polymyositis – the condition affects the muscles alone without any rash. It is usually not associated with cancer.

Inclusion body myositis – the condition causes severe muscle weakness and wasting throughout the body over a long period of time. Drug-induced myositis – the condition is triggered by the body’s response to a type of cholesterol lowering drug called statins. The symptoms of muscle pain and weakness can manifest over a short period of time, but patients can also improve rapidly once the medication is stopped. Who gets affected? Myositis is a rare condition, affecting about 5 to 10 persons per million worldwide. While it can affect people of any age, there are two main clusters of patients: children between the ages of 5 to 15 years and adults between the ages of 30 – 65 years. Generally, women are twice as likely to develop myositis than men. What are the symptoms? The major symptoms common to all forms of myositis are muscle weakness and muscle pain. Other symptoms vary, depending on the specific cause of the disease. In dermatomyositis and polymyositis, weakness usually affects muscles near the centre of the body like the neck, shoulders and hips.

Patients can experience difficulty with simple tasks like combing their hair, dressing, getting into a car, standing up from a sitting position or climbing stairs. About one third or half of such patients also have problems swallowing and often choke when drinking fluids. Some patients with dermatomyositis and polymyositis also have lung involvement which results in cough and breathlessness. General symptoms like lethargy, fatigue, weight loss and poor appetite are also very common. How is it diagnosed? Due to the many different forms of myositis and similarities to other muscular and nerve diseases, it may take a few visits to the doctor before the condition can be diagnosed.After a careful physical examination, the doctor will order other tests to confirm the diagnosis. Such tests may include: Routine tests like a full blood count and ESR and CRP. Blood tests for muscle enzymes and auto-antibodies. Muscle enzyme levels (usually raised initially) are useful for monitoring progress and response to treatment. An electromyogram (EMG) This is a test that measures the electrical activity of muscles. In patients with myositis the EMG would be abnormal. A muscle biopsy The doctor takes a sample of the affected muscle to be checked under the microscope.

The procedure is done under local anaesthesia. X-ray of the chest To investigate for lung cancer and lung involvement associated with myositis. Magnetic Resonance Imaging (MRI) This painless scan can identify abnormal muscles and can be used to locate the best site for a biopsy and to monitor the progress of the disorder. A chest and abdominal CT scan This test is useful to investigate for hidden cancers. Gastroscopy and colonoscopy These tests are useful to investigate for underlying cancers in the gastrointestinal tract. How is it treated? There is currently no cure for myositis. Treatment strategies focus on alleviating symptoms and managing the progression of the condition. a. Medications For dermatomyositis and polymyositis, doctors usually start with high dose corticosteroids (eg. prednisolone) for about 4 – 6 weeks. When the condition improves the dosage is then slowly reduced. Other immunosuppressive treatments may be added (eg. methotrexate). Intravenous immunoglobulin (IVIG) (an injection of antibodies) may occasionally be effective in cases that fail the above first-line treatments.

If IVIG is effective, it needs to be continued on a long term basis, although in lower doses to maintain the effect. Another form of treatment in patients who do not respond well to conventional drugs is plasmapharesis or plasma exchange. This is a type of blood cleansing in which the damaging antibodies are removed from the blood. Often the effect is temporary. In patients with drug-induced myositis, the medication causing the myositis will need to be stopped and replaced with an alternative. At the moment there is no effective treatment for inclusion body myositis. b. Exercise Physical therapy and specially designed exercise programmes are very important for recovery of muscle strength. c. Dermatomyositis associated with cancer Treatment of the underlying cancer should take priority either by surgery, chemotherapy or radiotherapy. What can patients expect? Most people with dermatomyositis and polymyositis eventually regain their strength with proper treatment. Many patients do not die of the disease per se but of complications like infections, especially that of the lung as a result of swallowing and breathing difficulties. Inclusion myositis usually progresses very slowly and does not affect a person’s lifespan unless complications like infections set in.

In most cases of drug-induced myositis, the symptoms subside when the offending drug is stopped. Concerns during pregnancy Pregnancy may worsen the signs and symptoms in women with active disease. Active Myositis can also increase the risk of premature birth or stillbirth. If the woman is in remission the risk is much lower. Always discuss with your doctor if you have pregnancy in mind. When to call a professional? Muscle pain and weakness that is progressive and does not go away with rest. A red or purplish rash on your face or around your eyes. Muscle pain and weakness that begins after you start taking a new medication like a cholesterol-lowering drug. If you have been diagnosed with myositis and develop a fever, cough or other forms of infection like skin infection, abscess or pain on passing urine. Any infections in patients with myositis need to be treated urgently and aggressively with antibiotics and often in hospitals. Coping and support Know your illness. Discuss with your doctor and nurse and seek more information from reliable sources. Have adequate rest and sleep. Eat a nutritious diet and pace your daily activities. Do not overdo things or tire yourself. Stretch often and do gentle exercises at home.

Keep a positive attitude and do not isolate yourself. Wear sunscreens when you go out into the sun, especially if you have a rash. Where to Seek Treatment Myositis Guide: Causes, Symptoms and Treatment Options Myositis What Is It? Myositis is the medical term for muscle inflammation. In myositis, inflammation damages the fibers of a muscle. This causes muscles to be weak by interfering with the ability of the muscles to contract. Although myositis can cause muscle aches and muscle tenderness, weakness is usually the dominant symptom. In some cases, myositis is a short-term problem that goes away after a few days or weeks. In other cases, it is part of a chronic (long-term) condition. Chronic forms of myositis can lead to muscle atrophy (wasting and shrinking) and severe disability. There are many different types of myositis, including: Idiopathic inflammatory myopathies. In this rare group of muscle diseases, the cause of the muscle inflammation is unknown (idiopathic). There are three major types: dermatomyositis, polymyositis and inclusion body myositis.

In the United States, idiopathic inflammatory myopathies affect about 1 out of every 100,000 people. Polymyositis and dermatomyositis are most common in women, whereas inclusion body myositis affects men more often. Symptoms can start at any age, but the average age of first symptoms is a bit younger in dermatomyositis and polymyositis (age 50) than in inclusion body myositis (age 60). So far, most of the evidence suggests that polymyositis and dermatomyositis are autoimmune disorders, illnesses in which the immune system mistakenly attacks the body's own tissues. The muscles of people with inclusion body myositis contain an abnormal protein called amyloid, but the reason it forms is unknown. This amyloid protein is similar to the protein deposited in the brains of people with Alzheimer's disease, and some experts believe that the two diseases may develop the same way. In inclusion body myositis, the muscle also contains tiny structures that resemble viral particles (called inclusion bodies), although no viral infection has been consistently identified in association with this disease.

In dermatomyositis, cancer is found in approximately 10% to 20% of cases. Sometimes, the muscle problem develops first. In other cases, the cancer is detected before the myositis. Myositis that is otherwise quite similar to polymyositis or dermatomyositis may accompany other autoimmune disease such as systemic lupus erythematosus (SLE) or progressive systemic sclerosis (also called scleroderma). Infectious myositis. Myositis sometimes occurs as part of a systemic (whole body) infection, especially a viral infection. It is especially common among people who have the flu (influenza). Myositis also can be caused by trichinosis, an infection in which tiny parasites invade the muscles. People can develop this infection by eating meat that has not been cooked enough. One type of infectious myositis is called pyomyositis, a bacterial infection that causes one or more pockets of pus (abscesses) inside a muscle. It usually is caused by Staphylococcus ("staph") bacteria. Pyomyositis is a relatively common infection in developing countries in tropical climates, especially where sanitation and health care are poor.

However, it sometimes occurs in the United States, primarily in people who inject illegal drugs and in people infected with HIV. Benign acute myositis. In benign acute myositis, a young child suddenly develops severe leg pain and cannot walk normally. These symptoms are dramatic and frightening, but they usually disappear within a few days. Benign acute myositis usually occurs in children who are recovering from the flu or some other respiratory infection caused by a virus. Doctors are not sure whether the child's muscle symptoms are caused by the virus itself or by the body's immune reaction to the virus. Myositis ossificans. In myositis ossificans, a lump of bony material forms inside a muscle. This usually happens after a muscle injury, especially a deep bruise. Drug-induced myositis. In drug-induced myositis, muscle inflammation occurs as a side effect of a medication or a combination of medicines.

Although this is rare, the most common medications that can cause myositis are the cholesterol-lowering drugs called statins, including atorvastatin ( Lipitor ), lovastatin ( Mevacor ) and simvastatin ( Zocor ) and zidovudine ( Retrovir ), also called AZT, a drug used to treat HIV/AIDS. Symptoms Symptoms of myositis can include muscle weakness, muscle pain and muscle tenderness. Other symptoms vary, depending on the specific cause of myositis: Idiopathic inflammatory myopathies. These conditions typically cause painless muscle weakness that develops slowly over weeks, months or years. Although up to 40% of people with 1 of these conditions have muscle pain, the weakness is usually worse than the pain. In polymyositis and dermatomyositis, weakness usually affects the muscles near the center of the body (called proximal muscles), including the muscles of the neck, shoulders and hips causing difficult with lifting, reaching over the head, or arising from a chair. Some patients also have difficulty swallowing. In dermatomyositis, skin symptoms accompany muscle problems.

These can include purple discoloration of the eyelids, a red rash on the face and neck, or scaly patches, usually on the knuckles. In inclusion body myositis, weakness typically starts in the upper legs and later affects the upper arms and muscles farther away from the center of the body (called distal muscles), including muscles of the hand and wrist and lower legs. Muscle wasting (atrophy) is often prominent. Up to one-half of these patients have trouble swallowing. Infectious myositis. When infectious myositis is caused by the flu, symptoms include not only muscle aches and muscle weakness, but also high fever, chills, sore throat, cough, fatigue and runny nose. When caused by trichinosis, symptoms in the early stages include diarrhea and vomiting. Later, as the parasites invade the muscles, symptoms can include fever, eye redness with swelling in the lids and muscle pain. Patients with pyomyositis usually have a fever, and the abscessed muscle is painful, tender and slightly swollen. Skin over the muscle may be red and hot. Benign acute myositis. A child suddenly has trouble walking and complains of severe leg pain.

This pain is often worst in the calf muscles. In most cases, the child also has a history of recent fever, runny nose, sore throat and other upper respiratory symptoms. Myositis ossificans. A lump appears in the affected muscle, and this lump may hurt when you press it. These symptoms usually begin several weeks after a muscle injury, especially a bruise. Drug-induced myositis. Symptoms include muscle soreness, pain and weakness. These symptoms usually begin soon after a person starts taking a new drug or a combination of drugs. Myositis is more common when a person is taking a combination of lipid-lowering medications, such as gemfibrozil ( Lopid ) and lovastatin (Mevacor), than when a single medication is used. Diagnosis Your doctor will ask you to describe your symptoms. It is especially important to describe the exact location of any weakness or muscle pain and how long you have had it. The doctor also will review your medical history and current medications. Next, your doctor will examine you, paying special attention to your muscles and nerves. Depending on what your doctor finds, he or she may order diagnostic tests.

Common tests used to diagnose muscle problems include: Blood tests to measure levels of muscle enzymes, auto-antibodies (antibodies directed against one's own cells or organs) and antibodies to infectious agents An electromyogram, a test that measures the electrical activity of muscles Magnetic resonance imaging (MRI), a painless scan that can identify abnormal muscle and can be used to locate the best site for a biopsy to establish the diagnosis or to monitor the progress of a known type of myositis A standard X-ray or a bone scan if your doctor suspects you have myositis ossificans An ultrasound, computed tomography (CT) scan or MRI if pyomyositis is suspected A muscle biopsy. With this test, the doctor takes a sample of muscle tissue to be checked under the microscope. Muscle biopsy is the best way to establish the diagnosis of myositis; it may be diagnostic if it shows clear muscle inflammation. However, the results are not always abnormal even in people who have myositis. Expected Duration How long myositis lasts varies depending on the cause: Idiopathic inflammatory myopathies. Polymyositis and dermatomyositis are usually chronic (long-lasting) but typically improve after one to two months of treatment.

Inclusion body myositis is also chronic. Since there is no reliably effective treatment for inclusion body myositis, symptoms usually worsen gradually over a period of years. If cancer is associated with the myositis, improvement may occur if the cancer is treated effectively. Infectious myositis. Flu symptoms usually last three to seven days. In trichinosis, symptoms peak in about three weeks, and then gradually subside. For pyomyositis, your doctor will drain the abscess and you will be given antibiotics. Once the infection is gone, healing can start. Recovery can take weeks or even months in people with chronic illnesses. Benign acute myositis. Patients usually recover within three to seven days. Myositis ossificans. In some cases, the bony lump disappears on its own. However, this can take a few months. If the lump does not go away, it may remain indefinitely or your doctor can remove it surgically. Drug-induced myositis. Symptoms usually disappear once you stop taking the drug. However, this can take weeks or months. Prevention Scientists do not know the cause of most forms of myositis.

For this reason, there are no official guidelines for preventing myositis. Only infectious myositis and drug-induced myositis are potentially preventable. To help prevent these illnesses: Get a flu shot each year. Thoroughly cook pork and other meats. Never inject illegal drugs under your skin or into your muscles. With prescription drugs that are injected, the injection site should be as clean as possible. Keep your skin clean. Take the lowest number and lowest doses of medications that are necessary. Routine blood tests to look for drug-induced muscle injury may be helpful as well. Treatment Treatment varies, depending on the type of myositis. Idiopathic inflammatory myopathies. For polymyositis and dermatomyositis, doctors usually begin treatment with a corticosteroid drug, such as prednisone (sold as a generic) or methylprednisolone ( Solu-Medrol , others). If this fails, methotrexate ( Rheumatrex ) or azathioprine ( Imuran ) may be added. Intravenous immunoglobulin (an injection of antibodies collected from blood donors) may be effective in cases that fail these other treatments.

Other immunosuppressant medications may be recommended to treat dermatomyositis and polymyositis, including cyclosporine , rituximab , mycophenolate mofetil or cyclophosphamide . Unfortunately, there is no reliably effective treatment for inclusion body myositis, although corticosteroid treatment and immunosuppressive therapies (as with polymyositis and dermatomyositis) are often tried for at least several months. If treatment is effective, ongoing therapy may improve strength or prevent worsening weakness. When myositis accompanies another autoimmune disease (such as SLE), treatment of the underlying disease may be helpful; otherwise, treatment of the myositis is similar to that of polymyositis and dermatomyositis. Infectious myositis. If you have the flu, you should rest in bed and drink plenty of fluids. You also can take nonprescription medicines for fever and muscle aches. If you have trichinosis, your doctor may treat you with mebendazole ( Vermox ) or albendazole ( Albenza ), antibiotic drugs that kill the trichinosis parasites. In addition, you should rest and take nonprescription drugs for pain.

Your doctor may also prescribe prednisone to reduce inflammation associated with the infection. For pyomyositis, your doctor may recommend drainage of the abscess by making an incision or by inserting a needle. In addition, he or she will prescribe antibiotics to fight the infection. Benign acute myositis. Your child's doctor will prescribe medication for pain. No other treatment is necessary, because the illness usually gets much better within a few days. Myositis ossificans. Your doctor may wait to see whether the bony lump disappears on its own. If it doesn't, he or she may recommend surgery to remove the lump. Drug-induced myositis. Your doctor will discontinue any medication thought to be causing myositis. Medications called corticosteroids may help you to recover faster.

When To Call a Professional Make an appointment to see your doctor if you have: Muscle weakness that doesn't go away A red or purple rash on your face that doesn't go away or scaly patches on your knuckles Muscle aches that don't go away with rest and nonprescription pain medication A lump in any muscle, especially if you also have a fever or other symptoms Muscle pain and weakness that begin after you start taking a new medication Call your doctor immediately if: You have a fever together with muscle pain and weakness You have a muscle that becomes hot, painful, swollen and stiff Your child complains of severe leg pain and has trouble walking Prognosis The outlook varies, depending on the type of myositis. Idiopathic inflammatory myopathies. With proper treatment, most people with polymyositis or dermatomyositis eventually regain at least some muscle strength. Often, muscle strength returns to normal. Typically, inclusion body myositis does not improve with treatment. However, the illness usually progresses slowly and does not affect a person's lifespan unless complications lead to serious illness, such as pneumonia caused by swallowing or breathing problems. Eventually, some patients need a cane to help them walk. Others require a wheelchair.

If a person with dermatomyositis develops cancer, the prognosis may be worse. Medications taken to treat these muscle diseases may cause complications that affect prognosis. For example, serious infections may complicate the use of immune suppressing medications. Infectious myositis. Once the flu passes, muscle symptoms improve. Treatment usually is effective, although recovery can be slow in people with trichinosis. For pyomyositis, the prognosis is good if the infection is treated promptly. If not, the infection can pass into the bloodstream and spread throughout the body. Benign acute myositis. Children typically walk normally again within a few days. Myositis ossificans. The prognosis is very good. If the bony lump does not disappear on its own, your doctor may recommend surgery to remove it. Drug-induced myositis. The prognosis is very good. In most cases, symptoms subside when the drug is stopped.

External resources National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse Myositis ossificans | definition of myositis ossificans by Medical dictionary Myositis ossificans | definition of myositis ossificans by Medical dictionary Related to myositis ossificans: Myositis ossificans progressiva myositis [mi″o-si´tis] inflammation of a voluntary muscle; called also initis . myositis fibro´sa a type in which there is a formation of connective tissue in the muscle. myositis ossi´ficans myositis marked by bony deposits in muscle. trichinous myositis that which is caused by the presence of Trichinella spiralis. my·o·si·tis os·sif·'i·cans ossification or deposit of bone in muscle with fibrosis, causing pain and swelling in muscles. myositis ossificans [əsif′əkanz] a rare inherited disease in which muscle tissue is replaced by bone. It begins in childhood, with stiffness in the neck and back, and progresses to rigidity of the spine, trunk, and limbs.

The administration of diphosphonates may prevent the abnormal deposition of bone, but there is no cure after it has occurred. Metabolism of calcium and phosphate remains normal throughout the course of the disease. Compare myositis . myositis ossificans A term that is slowly being retired from the medical literature, largely in favour of heterotopic ossification, given that (1) inflammation is not a necessary precursor for heterotopic ossification; and (2) the ossification doesn’t always occur in muscle, but may occur in fascia, tendons, and other mesenchymal soft tissues. Clinical forms, myositis ossificans • Localised: linked to trauma. • Generalised: now known as fibrodysplasia ossificans progressiva, which is often due to spontaneous mutation, resulting in autosomal dominant pattern of inheritance in the proband’s progeny.

myositis ossificans Bone formed within muscle; localized MO is 2º to trauma resulting from a blow or muscle tearing; generalized MO is AD, often accompanied by aplasia of the thumb, great toe, or rarely other digits, in which the first 'tumor' occurs in the paravertebral or cervical region, followed by multiple ossifying tumors, forming calcifying bridges across muscles and joints resulting in massive rigidity and the Pt is turned into 'stone'. See Zoning phenomenon. het·er·o·top·ic os·si·fi·ca·tion (het'ĕr-ō-top'ik os'i-fi-kā'shŭn) Growth of calcium deposits within soft tissue, usually at the site of a hematoma due to blunt trauma or in tissue atrophied due to central nervous system injury. Synonym(s): myositis ossificans . myositis ossificans A rare, usually familial, inflammatory disease of muscle in which CALCIFICATION occurs followed by the formation of bony tissue within the affected muscles.

myositis ossificans ossification (bone deposition) and fibrosis of muscle tissue; may be induced by traumatic muscle injury; characterized by local pain, swelling and dysfunction, and later atrophy, contracture and calcification myositis inflammation of a voluntary muscle. Causes heat, swelling, pain and lameness if a limb is affected. Trauma is the common cause, especially in racing and work horses. Blackleg is a specific myositis. See also polymyositis . atrophic myositis a form of masticatory myositis in dogs. There is a chronic, progressive atrophy and fibrosis of the masticatory muscles of dogs which finally makes it impossible for the mouth to be opened wider than a few inches. eosinophilic myositis 1. a form of masticatory myositis seen in German shepherd dogs. It is acute, often recurrent, and there is painful, bilaterally symmetrical swelling of the masticatory muscles, mainly temporals and masseters. Often there is an eosinophilia found in the hemogram. Occasionally other muscles are also involved. There is a progressive atrophy and fibrosis of the muscles, frequently resulting in an inability to open the mouth.

In the latter it may be confused clinically with atrophic myositis (above). 2. a lesion found at meat inspection. It reduces the value of the carcass. The cause is unknown. familial myositis Polymyositis & Dermatomyositis Symptoms and Diagnosis Medical Author: William C. Shiel Jr., MD, FACP, FACR William C. Shiel Jr., MD, FACP, FACR Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. Medical Editor: Catherine Burt Driver, MD Catherine Burt Driver, MD Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

Polymyositis and dermatomyositis (PM/DM) are chronic inflammatory diseases of muscle. Muscle weakness is the most common symptom of PM/DM. The cause of PM/DM is unknown. Diagnosis of PM/DM involves physical examination of muscle strength, blood tests for muscle enzymes, electrical tests of muscle and nerves, and is confirmed by muscle biopsy. Treatment of PM/DM involves high doses of cortisone-related medications, immune suppression, and physical therapy. What is polymyositis? What is dermatomyositis? Polymyositis is a disease of muscle featuring inflammation of the muscle fibers. The cause of the disease is not known. It begins when white blood cells, the immune cells of inflammation, spontaneously invade muscles. The muscles affected are typically those closest to the trunk or torso. This results in weakness that can be severe. Polymyositis is a chronic illness featuring progressive muscle weakness with periods of increased symptoms, called flares or relapses, and minimal or no symptoms, known as remissions. Polymyositis is slightly more common in females. It affects all age groups, although its onset is most common in middle childhood and in the 20s.

Polymyositis occurs throughout the world. Polymyositis can be associated with a characteristic skin rash and is then referred to as "dermatomyositis." Dermatomyositis in children is referred to as juvenile dermatomyositis. "Amyopathic dermatomyositis" is the term used to describe people who have skin changes compatible with dermatomyositis but do not have diseased muscle involvement. Polymyositis can also affect other areas of the body and is, therefore, referred to as a systemic illness. Occasionally, it is associated with cancer or with other diseases of connective tissue (such as systemic lupus erythematosus , scleroderma , and rheumatoid arthritis ). Depending on which other diseases it is associated with, it may be referred to as an "overlap syndrome" or " mixed connective tissue disease ." Medically Reviewed by a Doctor on 5/18/2016

Question: Medically, what is affected by Myositis?
Answer: THE MUSCLES